Sept 25 -- The Centers for Medicare and Medicaid Services (CMS) invites comments to OMB by October 25, 2023 regarding proposed revisions to Part C Medicare Advantage Reporting Requirements.
The Centers for Medicare and Medicaid Services (CMS) established reporting requirements for Medicare Advantage Organizations (MAOs) under the authority described in 42 CFR 422.516(a). Each MAO must have an effective procedure to develop, compile, evaluate, and report to CMS, its enrollees, and the public at the times and in the manner that CMS requires.
In accordance with 42 CFR 422.516(a), each MA organization under Part C Medicare is required to have an effective procedure to provide statistics indicating:
-- The cost of its operations.
-- The patterns of utilization of its services.
-- The availability, accessibility, and acceptability of its services.
-- To the extent practical, developments in the health status of its enrollees.
-- Other matters that CMS may require.
These Part C Reporting Requirements will provide key data to CMS on the utilization and cost of these benefits that has not been available since the removal of benefit utilization requirements in 2011. This proposed collection will also build upon the previous collection-by asking for information regarding all unique supplemental benefits categories. These categories match the current Plan Benefit Package (PBP) which is submitted annually by plans. Additionally, the proposed collection will request information to be split out by the authority under which each plan offers the benefits (mandatory, optional, mandatory-SSBCI, mandatory-Uniformity Flexibility).
There are a number of information users of the Part C reporting requirements. They include CMS staff that use this information to monitor health plans and to hold them accountable for their performance. CMS users include group managers, division managers, branch managers, account managers, and researchers. Academic researchers and other governmental entities such as GAO and the Office of Inspector General have inquired about this information.
Health plans can use this information to measure and benchmark their performance. CMS receives inquiries from the industry and other interested stakeholders about the beneficiary use of available benefits, including supplemental benefits, grievance and appeals rates, cost, and other factors pertaining to use of government funds, as well the performance of MA plans.
Part C Reporting Requirements
https://www.cms.gov/medicare/enrollment-renewal/health-plans/part-c
CMS submission to OMB:
https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=202309-0938-012 Click IC List for information collection instrument, View Supporting Statement for technical documentation. Submit comments through this webpage.
FRN:
https://www.federalregister.gov/d/2023-20739 #5
For AEA members wishing to submit comments, "A Primer on How to Respond to Calls for Comment on Federal Data Collections" is available at
https://www.aeaweb.org/content/file?id=5806